Tuesday, June 15, 2010


Here is the law that I *thought* pertained to the supervision of CRNA's.

42CFR485.639 (2) In those cases in which a CRNA administers the anesthesia, the anesthetist must be under the supervision of the operating practitioner except as provided in paragraph (e) of this section. An anesthesiologist's assistant who administers anesthesia must be under the supervision of an anesthesiologist.
(2)(e)Standard: State exemption. (1) A CAH may be exempted from the requirement for physician supervision of CRNAs as described in paragraph (c)(2) of this section, if the State in which the CAH is located submits a letter to CMS signed by the Governor, following consultation with the State's Boards of Medicine and Nursing, requesting exemption from physician supervision for CRNAs. The letter from the Governor must attest that he or she has consulted with the State Boards of Medicine and Nursing about issues related to access to and the quality of anesthesia services in the State and has concluded that it is in the best interests of the State's citizens to opt-out of the current physician supervision requirement, and that the opt-out is consistent with State law.

Seems pretty straight forward doesn't it? Guess again... Here is a reply I got from Anesthesia Provider Pay to Drop 60% - Page 6- Nursing for Nurses#post4360046 "This (law) deals with billing for CMS services. There is not a federal law that deals with supervision of CRNAs. Scope of practice issues are dealt with on the state level.

You can call it whatever you want, but the practical aspect is that CRNAs in every state suffer no more supervision than the operating practitioner requesting anesthesia. There is a big difference between meeting a legal/billing definition for "supervision" and actual supervision

According to this poster the law as quoted is only giving permission for billing practices that in my non lawyerly thinking constitute FRAUD! "There is a big difference between the legal/billing definition for "supervision" and "ACTUAL supervision.'" So, to you and me this law clearly states that CRNA's are required by law to be supervised, but it actually means that they can BILL for supervision without actually PROVIDING supervision. Health care has gone mad. No wonder health care costs are through the roof. Not only are they injecting us with a patient control and amnesia drug for their own gratification which adds thousands of dollars to any medical procedure, they are also BILLING for other services which are not being provided. I wish they would dispense with the Versed and quit billing for a supervisor when none is provided. Just cost cutting...

Do you want an ANESTHESIA ASSISTANT doing your anesthesia alone? That's even worse than the nurse doing it. According to this poster from http://www.allnurses.com/ your anesthesia assistant is on his or her own as well. (It would follow the line of reasoning that this person sets forth. If the law about supervision doesn't pertain to CRNA's then neither does the law of supervision for the anesthesia assistant pertain to themselves.) Have you seen anything in your "informed consent" about this? Is there a place on the "informed consent" where you give permission for a sketchily trained CRNA (in my opinion based on my personal experience)or a practically untrained anesthesia assistant (also IN MY OPINION), these people are NOT doctors and aren't in the same league.) to perform your anesthesia, ALONE? Not on your life. That informed consent probably vaguely mentions that you will allow anybody your physician chooses to do whatever they choose to you. Obviously this is all just more double speak from our "professional" health care people. It's unbelievable that these people can't read plain English and go on to interpret the law to mean something entirely different than the law as it is written.

Here's a recent lawsuit about this very subject;Doctors Sue To Stop Unsupervised Nurse Anesthetists from Administering Anesthesia Apparently California legislators don't understand the LAW as it pertains to this either.

EVEN IF federal regulations state that in order to get FEDERAL funds you must comply with the above law, most hospitals accept medi-care. If these entities violate the law as written and deviously choose to interpret the law as the poster from http://www.allnurses.com/ does, doesn't that mean that they risk losing reimbursement for these patients? Can they no longer accept patients unless they are privately insured so that they can continue this apparent fraud? Are these hospitals et al even allowed to deny care to medi-care patients? If not, then they must follow the law as it is written, right? Hence the odd interpretation...

The more I delve into this, the worse it becomes.

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